1.800.469.6292Plan Materials and Resources
Member Materials
| 2021 Annual Notice of Changes (ANOC) | English Español 中文 |  |
|---|---|---|
| 2021 Summary of Benefits | English Español 中文 Русский | |
| 2021 Evidence of Coverage | English Español | |
| 2021 Provider and Pharmacy Directory | Bronx Brooklyn Manhattan Queens | |
| 2021 Formulary | English Español 中文 | |
| 2021 Extra Help Premium Summary Table | English Español 中文 | |
| Language Assistance | English Español 中文 Creole Русский Italiano 한국 | |
| Enrollment Form | English Español 中文 Русский | |
| Prescription Drug Claim Form | English | |
| Appointment of Representative Form | English Español | |
| Health Care Proxy Form & Information* | English Español 中文 Creole Русский Italiano 한국 | |
| Part D Coverage Determination Form | English | |
| Member Reimbursement Form | English (coming soon) | |
| Part D Coverage Redetermination Form | English Español 中文 | |
| Prescription Drug Mail Order Form | English | |
| Privacy Notice | English | |
| Notice of Non-Discrimination | English Español 中文 Creole Русский Italiano 한국 | |
| 2021 Medicare Star Ratings | English Español 中文 Русский | |
Member Resources
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CMS Best Available Evidence Policy |
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H2168_MKT21-19_M 09272020
This page was last modified on October 15, 2020
This page was last modified on October 15, 2020
